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The painful collision of rhetoric and reality on health care

The coming fight on health care ultimately isn't about laws, statistics or debating points – it's about people. About whether mothers and fathers can afford health care for their families, about whether workers won't be denied health insurance because of a pre-existing condition, and about whether senior citizens will be able to afford their prescription medicines. Republicans have been able to hide the truth about what will happen to these people under a repeal of the Affordable Care Act (ACA) because they have said everything would be taken care under their replacement, which remains nonexistent after years of promises.

Now the moment of truth has come when the GOP controls Congress and the White House, and yet once again Republicans have not produced any plan to replace the health coverage they plan to rip away from millions of Americans. Instead, Republicans are suggesting they will repeal the law's health coverage with a delayed effective date, and then come up with an alternative in the interim.

This is nothing less than legislative malpractice. First, if Congressional Republicans haven't come up with a replacement by now after attempting to repeal the health reform law dozens of times, there is no reason to think that they will ever find a credible replacement. Just within the last few weeks, the Dallas Morning News ran an article with the headline, "Republicans set to repeal Obamacare but can't agree on what comes next," highlighting how little the GOP has done to forge any real replacement.

Second, the Republican repeal bill will likely gut many of the provisions that finance the subsidies that help Americans afford health coverage under the ACA. Without those provisions, any GOP replacement would have to either cut way back on assistance for moderate-income families, or go after other health care programs, such as Medicare and Medicaid, to find savings. It's like knocking down someone's house and also taking the insurance money needed to rebuild it.

And guess where the money goes under the Republican plan? According to an analysis by the Tax Policy Center, the primary beneficiaries of the GOP plan to eliminate these health care financing provisions are those with annual incomes in excess of one million dollars, while those put most in jeopardy of losing subsidies for their health care coverage are Americans earning between $20,000 and $50,000 a year. I can't think of a more wrong-headed and cruel-hearted policy than taking health care away from hard-working families to give millionaires a huge tax cut.

Third, Congress has received numerous warnings that a delayed repeal of the health care subsidies and other provisions in the ACA will create immediate and major problems for Americans now receiving coverage under the law. The American Academy of Actuaries has highlighted concerns about premium rate hikes under the GOP plan in a letter to Speaker Ryan, saying "Delaying the effective date of repeal while a replacement is worked out likely won’t be enough to assure the stability and sustainability of the individual market." Health plans, hospitals and researchers have all echoed this same worry.

Realizing that it may be finally held accountable for its rhetoric on health care, the GOP is now pushing another falsehood: namely that the ACA is falling apart anyway, so it doesn't matter if Republicans destroy it. This baseless claim is undercut by a wealth of data, including the facts that enrollment for coverage under the Act's marketplace is higher now than this time last year or in any other year, the rate of Americans without health insurance is at an all-time record low, and over 20 million Americans now depend on the law for their health care. In speaking directly to hospitals in Michigan, I also heard another major benefit of the law: increased access to primary care and reduced reliance on emergency room care.

The truth – that any repeal will harm millions of Americans – cannot be avoided forever. And when it comes, it will be politically painful for Republicans. But of much greater importance, it will be personally painful for millions of Americans, unless the public helps us stop this coming train wreck.

U.S. Rep. Sander Levin, (D-Mich.), represents Michigan’s 9th District. He was the chairman of the Ways and Means Committee, which has jurisdiction over health and tax policy, when the Affordable Care Act was signed into law.